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For most of us, the importance of brushing and flossing has been deeply ingrained from a young age. Many of us feel guilty as adults for failing to floss every single day.
Flossing is one of the most common and accepted health recommendations. It is right up there with the importance of eating vegetables and drinking water.
Yet, how many of us have actually researched flossing?
We’ve been told to do it from such a young age that we assume its beneficial. But it it really as important as we’ve been told?
I was a daily flosser for years upon the recommendation of my dentist (here’s what I used), but since converting to more natural oral health options it hasn’t been as much of a priority for me.
The internet is abuzz with debate after the recent publication of an AP article called “Medical Benefits of Floss Unproven.”
Surprised?
Despite the sensationalist headlines, the study didn’t conclude that flossing is bad, just that there may not be any scientific reason to do it. Let’s look at the actual research and see what science really says about flossing.
The Logic of Flossing
At first glance, flossing seems to make perfect sense.
Food gets stuck between teeth. Floss removes this food. Thus, flossing is good.
Unfortunately, it isn’t quite so simple. There is also the issue of bacteria in the mouth, between the teeth and in the gums. This bacteria is what actually causes cavities and gum disease. This is well-documented:
Streptococcus mutans is the main cause of dental decay. Various lactobacilli are associated with progression of the lesion. (source)
Bacteria Lead to Cavities and Gum Disease
It is generally understood that cavities and gum disease occur in this way:
- Plaque forms in the mouth when we eat sugars and fermentable carbohydrates.
- The plaque creates acid which leads to mineral loss on the surface of the tooth.
- In a healthy mouth, the saliva will replenish the minerals on the teeth and teeth will remain strong. This is also why diet is important, as the body must have enough minerals to supply saliva.
- If a person consumes sugars and simple carbohydrates regularly, the minerals on the tooth can’t be replenished each time. The plaque builds up and creates acid that maintains a low pH (acidic) environment in the mouth.
- This creates an optimal environment for bacteria like S mutans and allows them to take hold, eventually leading to cavities and gum disease.
Does Flossing Help Reduce Bacteria in the Mouth?
This is the important question when it comes to flossing. If the acid>sugar>bacteria equation is the reason for cavities and gum disease, stopping these bacteria is very important to avoiding problems in the mouth.
But does flossing help?
According to dentist Dr. Reid Winick, flossing is not effective at removing this bacteria, and it may actually make things worse! He explains that these bacteria in the mouth affect the body in many ways:
If these pathogenic bacteria grows out of control and enter our blood stream, they can be transported through the body and cause inflammation. Chronic inflammation of any source leads to chronic disease. Failing to take care of your teeth may set you up for a range of serious medical issues such as heart disease, diabetes, preterm birth delivery, alzheimer’s and even inflammatory cancers like breast and pancreatic cancer.
But that flossing won’t fix the problem. In fact, he argues that the idea is laughable:
Don’t be fooled, flossing is not the answer! To me, it’s common sense. How can you kill an infection with a piece of string, especially if it can’t reach the bottom of the pocket where the infection lives?
The Stats About Flossing:
- Approximately 98.4% of adults report to their dentist that they floss regularly when asked.
- Approximately 60.5% of those people are lying.
- Also, 68% of statistics on the internet are made up, at least according to Abraham Lincoln.
All joking aside, when you actually start looking at the research, the “well-documented” benefits of flossing don’t stand up to scrutiny. This doesn’t necessarily mean that flossing is bad or not helpful, just that it deserves a closer look.
A Closer Look
The recent article that examines the evidence for flossing does so because the most recent American Dietary Guidelines make no mention of flossing. In the past, flossing has been part of their recommendations, but were noticeably missing in the most recent updates.
So what happened?
By law, these guidelines must be based on well-documented scientific evidence. About a year ago, the Associate Press requested documentation from the Department of Health and Human Services and the Department of Agriculture about the benefits of flossing.
Instead of responding, the recommendation to floss was simply removed from the guidelines this year.
In other words, the government’s Dietary Guidelines for Americans no longer recommends flossing.
Research about Flossing
The Associated Press examined the actual research about flossing. They looked at 25 studies that compared brushing alone or brushing+flossing and found that there was very little evidence for flossing with a large potential for bias.
The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,” said one review conducted last year. Another 2015 review cites “inconsistent/weak evidence” for flossing and a “lack of efficacy.”
In fact, in recent years, several reviews have looked at the available research about flossing and attempted to determine if there was a benefit or not:
Recent Studies & Reviews
- The first review looked primarily at children up to age 13. This review determined that children who had their teeth flossed by a trained dental hygienist at least five times a week noticed a 40% reduction in cavities and gum disease. Unfortunately, this reduction was not present in kids who flossed on their own. Since most of us don’t have trained dental professionals floss our teeth for us daily, the study concluded that the benefit of flossing was undocumented or limited at best.
- The second review out of Amsterdam looked at available studies and determined: “In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence.”
- The third and final review in recent years was the biggest to date: “Twelve studies, encompassing nearly 1,100 subjects were deemed suitable. Flossing was found to yield statistically significant reductions in levels of gingivitis and plaque buildup, however the reductions were minuscule, almost to the point of being unnoticeable. And in regard to reducing plaque, the authors deemed the evidence to be “weak” and “very unreliable.”
So, if flossing isn’t all that beneficial for reducing bacteria, cavities or gum disease, what can we do to avoid these problems?
Beyond Flossing: Other Ways to Reduce Bacteria
Thankfully, while flossing may not be as helpful as we once thought, there are other ways to keep the mouth healthy. Aside from brushing with a good natural toothpaste, you can try these alternatives:
Oil Pulling
This is one method I’ve been personally doing for years. I have seen a definite reduction in plaque and tooth/gum sensitivity since adopting this practice.
What is it?
The name is a bit misleading, but it is essentially the process of using oil as a mouthwash. This post explains how to do oil pulling, but it involves swishing an oil such as sesame or coconut oil in the mouth for up to 20 minutes (sometimes with added essential oils).
This is beneficial, because it reaches between teeth. The oil may help penetrate and break down the plaque. Additionally, oils like coconut oil can kill the S mutans bacteria that leads to tooth decay. This makes oil pulling a great addition to an oral health routine.
Mouthwash
I’ve seen several articles since the AP article was published that were written by dentists suggesting mouthwash as an alternative. They point out that mouthwash (like oil in oil pulling) can reach between teeth and the edges of the gums. For this reason, mouthwash can reach bacteria that floss can’t and it is typically designed to kill bacteria in the mouth. (Here’s my own herbal mouthwash recipe if you’re interested in making it yourself.)
To be clear, most dentists still recommend flossing, but suggest adding mouthwash or another method to the mix as well.
Oral Irrigation
Oral Irrigation is another method that can help address bacteria in the gums and between teeth. My own dentists recommended when I was younger and I used a Water Pik for years. Like mouthwash, the idea is that the water can reach between teeth and into gums to address bacteria in the mouth.
Bottom Line: Does Flossing Matter?
Flossing may not be as important as we once thought, but it is still beneficial for food stuck between teeth. In light of the recent research, we can probably stop feeling guilty if we don’t floss every single day. It may also be a great idea to add oil pulling or mouthwash to specifically address bacteria like S mutans in the mouth.
This article was medically reviewed by Dr. Steven Lin, who is a Board accredited dentist trained at the University of Sydney. With a background in biomedical science, he is a passionate whole-health advocate, focusing on the link between nutrition and dental health. As always, this is not personal medical advice and we recommend that you talk with your doctor or dentist.
Fess up… are you a daily flosser? What do you think of the recent news?
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I’m surprised at this article and research. Flossing doesn’t kill bacteria, but- that’s not the reason to use it. It helps remove food particles and also plaque that starts to build up right around the 24 hour mark after the last flossing and brushing, so flossing once a day is ok- (you don’t have to be strict about flossing twice a day- although a lot of dentists will disagree.) The amount of “white sticky stuff- the pre-plaque” will build up faster in people with certain kinds of saliva, like me. I have to get my teeth professionally cleaned every six months. My husband, on the other hand, can go a couple years, literally, he has very little plaque.. (So don’t blame yourself if your fight against plaque seems like a losing battle.) But the main reason to floss is because it relieves bad breath. If a person brushes without flossing, you can look in the mirror and see food particles still in-between teeth, or the white sticky plaque which will start to smell in a day or so if not removed. The same smell as food that would eventually rot if not kept in the fridge. You may notice when getting a tooth drilled for a filling that there is a rotten smell sometimes. That is old food in between the teeth that has rotted. When my dentist told me that, I felt embarrassed, and now I make it a point to floss.
I think you might be confusing plaque with tartar (calculus). Plaque is the soft “white sticky stuff” made up primarily of a biofilm of polysaccharides and bacteria that can be removed by brushing, flossing, interdental brushes or picks, water irrigators, etc. When plaque becomes mineralized, it turns to the hard tartar that can only be scraped off with an instrument. Some people do build up more tartar despite their best efforts due to many factors such as diet, genetics, or the mineral content and buffering capacity of their saliva. It truly isn’t fair!
And how many on this site actually believe anything in the American Dietary Guidelines? What they have none for the American people other than create generations of disease?
My thoughts exactly! They are not near being a reliable source of information that will promote/better our well-being. Seems like they, as well as most, if not all, other government-based research/guidelines/associations, has an agenda that is nothing like our own.
For a long time I have honestly tried to floss everyday, but just can’t get it to a habit. This kind of questioning of whether it is really effective has been recurrent in my mind from time to time. I concluded that floss is a positive thing when you think about removing stuck stuff from between your teeth. I know my teeth. I know which of them have a gap in between, which needs extra care to make sure is really clean. Some others never get anything stuck. As for cleaning up bacteria, I agree with Dr. Winick that you can’t expect killing bacterial infection with a string.
Actually, when tried to floss everyday, every single tooth, I noticed my gums are much proner to bleeding.
So now I am a happy once-in-a-while-or-according-to-the-need flosser, rather than an everyday flosser. 🙂
I’ve never glossed and definitely don’t lie to my dentist about it. What I do do is use a Sonicare toothbrush. Been doing it for about 20 years and never had a cavity or any other tooth issues except for a spot that food gets stuck behind a wisdom tooth that never fully emerged. My teeth are so good that my dentist only wants to see me every few years now. I’ll never give up this brush.
I have oil pulled for 5 minutes at a time successfully. As for the flossing, since my hands are twisted from arthritis, I floss using a long handled Reach brand floss. It doesn’t happen daily but several times a week is better than none at all.
This is very interesting. I am (honestly!) a daily flosser, and have been for years. I can’t go to bed without brushing and flossing. However, I’d love to have one less thing to do! I’ve really got to try oil pulling…I’m just so darn lazy 🙂
The last time I went to the dentist my hygienist asked me what she could do for me. I replied, “Don’t yell at me for not flossing.” She laughed so hard she had to wipe tears away. I’m not an avid flosser and never have been.
Very interesting info–as a retired dental hygienist I could always tell who flossed and who didn’t. The condition of the gums was very different. People who didn’t floss bled a lot when receiving their cleaning.People who flossed bled very little. And with the over the counter mouthwashes, they are designed to kill bacteria. They don’t differentiate between the good and bad bacteria. There is bacteria on our skin and in our oral cavity that is there for a positive reason.
I’m not saying their research is inaccurate but I only know what I observed when I was in practice full time.
I would have to agree with you. Flossing does help the conditioning of the gums. I have Lyme’s and during flares, I sometimes feel so bad that brushing is about all I can manage. When I get to feeling better, my gums bleed for a few days during flossing but then they get much better. There has to be some benefit to flossing.
I actually floss everyday and my gums still bleed like crazy when I go to the dentist. My dentist was impressed I flossed so well but as soon as I started bleeding he handed the job to someone else.
This good vs. bad bacteria in the mouth is something I read about recently. It is very intriguing based on my knowledge of the gut and the good bacteria needed. I too worry about mouth washes because of this argument. I have a son who is only 6 and we are struggling with decay and though our diet isn’t perfect, I feel it could be much worse. My other son doesn’t have this problem. I was thinking of starting mouthwash, but am so confused.
To Stephanie: Some people are more prone to decay than others. I am one of those people and am a dental hygienist. Check with your dentist for ways to help him. Also he has to be very good about diet and brushing. I am a daily flosser and it has helped me tremendously. Children can be much different. There is a lot of alcohol in some mouthwashes so be careful. I know that fluoride is controversial but, has been a lifesaver for people that are prone to decay. Just my thoughts.
Dental Hygienists are masochists!
Just Joking!
But you cant feel my pain…I can tell when you are cleaning my teeth!
What is the significance of bleeding a lot or a little while getting your teeth professionally flossed? Does losing a tad more blood every 6 months impact our overall health significantly?
It isn’t normal to bleed!!! If your eyes bled, your nose, any part of your body, that would be cause for alarm, wouldn’t it??? No different for ones gums!!! Would you want swollen, bloody, stinky limbs or healthy ones?? Have you ever smelt someone’s breath with gingivitis or gum disease??? I have. ???????
Maybe the gums bleed because we are unnaturally irritating them with some random object (string, toothbrush, etc.)… Just saying, we don’t go poking our eyes or noses with random things…
Contact lenses, kleenexes…..
I imagine another value of flossing is stimulating the circulation in the gums. Couldn’t hurt! I’ve become a regular flosser and have not had success with oil pulling as the thought of holding warm anything in my mouth for 20 minutes, swishing it around grosses me out!
One of the problems with using mouthwash is so many of them have glycerin, just as most toothpastes do (even the ones that are fluoride-free and SLS-free).
Want to allow those teeth to remineralize? Stop covering them in glycerin. Throw your Tom’s of Maine, your Dessert Essence, etc., into the garbage and use something like Uncle Harry’s toothpaste/powder (and mouthwash) products. There are a few others on the market now too. Or, make your own toothpaste/powder.
Like this one 😉 https://wellnessmama.com/2500/remineralizing-toothpaste/
As a dental hygienist, I am outraged that flossing is being dismissed as not needed. I see first hand, all day, every day the health and benefits flossing brings to patients. It prevents gum disease, bleeding, cavities, tarter buildup. Whoever wrote this is clueless. If you already floss daily I challenge you to stop and see the difference in your cleanings next visit. You will go back to it, I promise you!!!!
To Stephanie: Some people are more prone to decay than others. I am one of those people and am a dental hygienist. Check with your dentist for ways to help him. Also he has to be very good about diet and brushing. I am a daily flosser and it has helped me tremendously. Children can be much different. There is a lot of alcohol in some mouthwashes so be careful. I know that fluoride is controversial but, has been a lifesaver for people that are prone to decay. Just my thoughts.
I agree with Susan the other dental hygienist. I worked for 8 years in a specialty periodontal office. The difference is very apparent to hygienists and doctors of who flosses and who doesn’t. No matter what patients tell us, the mouth tells us what they really do for home care. Some people have underlying health issues that contribute to disease in the mouth, ex. diabetes. dry mouth, heavy saliva, etc. I would be very afraid if people stopped flossing. It is well documented that dental disease can affect heart disease. The purpose of flossing is not only to dislodge food but, to disrupt the colony of bacteria growing in the mouth. It is so far the only thing that has been found to do this effectively. Other dental apparatus may help but, doesn’t do the same. The water pik makes your mouth feel wonderful and can help but, doesn’t do what flossing does.
I used to floss (recently replaced with interdental brush that seems to remove more particles from between teeth). I bought a water pik some months ago and was shocked at how much more it removed, even after thorough brushing and flossing. I think you’re undervaluing the benefits of “water flossing” (water pik) as far as reaching into areas that brushing and flossing don’t, especially along the gum line inside. My gums (and teeth) are much healthier since using the pik. It should also be mentioned that many of us are deficient in minerals (except calcium), not all of which can be maintained by diet alone and may require some supplementation (e.g., getting enough all-important magnesium, as well as some trace minerals, is difficult through diet alone).
Figures, you so called professionals would say something completely ignorant ; hence the ignorance in the word ignorant. I remineralized my teeth by eating grass fed butter oil and cod liver oil . My cavities healed and my teeth are plaque free. By the way I don’t floss. Ha! I don’t ever have to waste money on you quacks!!
You don’t have to be so rude….sheesh!!! I don’t think calling us professionals quacks and ignorant was called for. I’ll take the higher road and not tell you what I think of you and your butter.
Same here, I changed my diet and stopped flossing too. And I’ve recently been to the dentist who didn’t ask me or tell me I needed to floss. Usually they’d ask me when the last time I flossed was. I think a lot of it does have to do with diet! If you’re eating grass-fed versus gmo beef, you’re already making a difference.
I Agree with You!!
I floss every day… Sometimes as much as 6 times a day…
I have seen inprovements from not flossing to flossing with both my Child and myself….
Flossing removes stucked food, plus sometimes it also helps kill bacteria (cause some floss brands have Peppermint -a natural anitibacterial- Added to the floss)…
Flossing is a must in my opinion…
my dental visits have been much better since I quit flossing and switched to a water pik. I have crooked teeth and many caps and crowns, and roughness that shreds floss. My dentist is much happier with the results of the water pik. If someone wants to floss six times a day then go for it but I love my water pik. 🙂
I have been brushing/pulling with coconut oil/tea tree oil blend and my teeth are stronger, cleaner, and whiter than ever! I still use regular toothpaste every morning, but the oils during afternoon and evening. Rarely floss, only a few times per week.